Successful Surgical Correction Research Articles

Right superior caval vein draining into the left atrium—diagnosis by color flow mapping

AbstractWe report two female patients, one aged four years and the other a newborn, referred for evaluation of cyanosis with otherwise normal cardiovascular findings, who proved to have the right superior caval vein draining into the morphologically left atrium. In both patients, the diagnosis was made by color flow mapping. The older child underwent catheterization and subsequent successful surgical correction. A right superior caval vein draining into the left atrium, although very rare, should always be considered a diagnostic possibility in the presence of cyanosis and normal clinical findings. Color flow mapping is an excellent method with which to make the diagnosis.

First Case of Human Infection Caused by Pasteurella gallinarum Causing Infective Endocarditis in an Adolescent 10 Years After Surgical Correction for Truncus Arteriosus

To report the first case of human infection (infective endocarditis [IE]) caused by Pasteurella gallinarum and to review the literature regarding IE caused by the genus Pasteurella. University hospital based. An adolescent boy who underwent successful correction for truncus arteriosus 10 years before the present illness. Persistent fever, pallor, and a palpable spleen suggested IE clinically. Echocardiography documented vegetation in the conduit that was used for surgical correction. Blood cultures grew P. gallinarum and confirmed its role as the causative organism for IE in the patient. This case illustrates that IE may develop in a child with congenital heart disease several years after surgical intervention using material that is foreign to the body (conduit), and that such a complication may involve unusual pathogens. These observations emphasize the need for careful long-term follow-up of children with congenital heart disease even after successful surgical correction.

Testicular Growth After Successful Varicocele Correction in Adolescents: Comparison of Artery Sparing Techniques With the Palomo Procedure

Testicular growth after varicocele surgery was evaluated in 116 boys 9 to 20 years old. A total of 88 boys was available for followup testicular examination 3 to 60 months after successful varicocele repair (mean 25). Left testicular volume loss of 2 cc or greater was present preoperatively in 72 of the 88 patients. The Palomo procedure was performed in 36 cases and repair using artery sparing techniques was done in 36. Mean relative left testicular volume increased 18% in the artery sparing group and 21% in the Palomo group. The increase in relative testicular volume compared to preoperative volumes was statistically significant in both groups (p < 0.05). There was no significant difference in testicular growth between the groups and no postoperative testicular atrophy was observed. A comparison group of 8 boys with uncorrected varicoceles demonstrated a mean relative volume increase of 3% (mean followup 22 months). The increase in testis volume in successfully corrected cases was statistically different (p < 0.05) from that of uncorrected cases. We conclude that reversal of varix induced testicular growth failure occurs only after successful surgical correction. The Palomo procedure resulted in equivalent testicular growth compared to the artery sparing techniques with fewer complications and no testicular atrophy despite intentional ligation of the testicular artery. Based on our data, we believe that the Palomo procedure should be the procedure of choice for adolescent varicocele correction.

Cor Triatriatum Dexter Echocardiographic Diagnosis and Successful Surgical Correction in an Infant

Cor triatriatum dexter is a very rare cardiac malformation in which the right atrium is subdivided into two distinct chambers. The authors report the case of a three-day-old infant boy with body weight of 2.8 kg, severely symptomatic, with highly obstructive cor triatriatum dexter and patent foramen ovale. The malformation was diagnosed by two-dimensional echocardiography and corrected successfully by surgery.

Rheumatic involvement of all four heart valves — preoperative echocardiographic diagnosis and successful surgical management

Rheumatic disease of all four heart valves is rare. We report on a patient with quadrivalvar involvement by rheumatic disease, diagnosed preoperatively by echocardiography, who underwent successful surgical correction. The implications of organic involvement of the pulmonary valve by rheumatic process is discussed.

Reconstruction of hypoplastic aortic arch and coarctation in a 720-gram premature infant

The case of a 720-g infant born at 29 weeks of gestation who underwent successful surgical correction of a hypoplastic aortic arch and aortic coarctation is presented. The infant was initially brought to surgery with an echocardiographic diagnosis of patent ductus arteriosus with left to right shunt unresponsive to indomethacin therapy. The correct diagnosis of hypoplastic aortic arch and severe coarctation with ductal dependent blood flow to the lower body was made intraoperatively. This case illustrates the danger of limited diagnostic testing in premature infants assumed to have isolated patent ductus arteriosus, and also that these small infants can undergo successful surgical repair of complex aortic arch lesions.

TRAUMATIC INTRAMYOCARDIAL DISSECTION SECONDARY TO SIGNIFICANT BLUNT CHEST TRAUMA

The case of a patient with delayed mitral regurgitation and right coronary artery traumatic injury in association with intramyocardial dissection without rupture or pseudoaneurysm is presented. These findings evolved secondary to blunt chest trauma and were confirmed by cardiac ultrasound scanning, magnetic resonance imaging, and cardiac catheterization. Successful surgical correction was facilitated with this combination of diagnostic testing.

Obstructive vs nonobstructive dilatation of the renal collecting system in children: distinction with duplex sonography.

The resistive index in cortical or arcuate renal arteries of children was calculated to determine whether obstructive uropathy could be differentiated from nonobstructive dilatation. Kidneys (n = 176) were prospectively evaluated by using duplex Doppler sonography in patients 3 days to 20 years old. Obstruction was confirmed by renography with furosemide and/or by surgery. The normal resistive index was 0.57 +/- 0.06 and the normal difference in resistive indexes between kidneys was 0.03 +/- 0.02 (n = 15). Abnormal values indicative of ureteropelvic junction obstruction were defined as the normal mean +/- 2 SD (i.e., a resistive index of > or = 0.70 plus a difference in resistive indexes between kidneys of > or = 0.08). Patients with unilateral dilatation and obstruction at the ureteropelvic junction (n = 20) had a mean resistive index of 0.77 +/- 0.05 and a difference in resistive indexes between kidneys of 0.16 +/- 0.05 (p < .001 compared with patients with normal kidneys and p < .001 compared with patients with unilateral dilatation without obstruction). Patients with unilateral dilatation but without obstruction (n = 16) had a mean resistive index of 0.63 +/- 0.06 and a difference between kidneys of 0.06 +/- 0.04 (values within normal limits). The positive and negative predictive values of the obstruction criteria for unilateral collecting system dilatation were 95% and 100%, respectively. After successful surgical correction of ureteropelvic junction obstruction (n = 29), patients had a normal mean resistive index of 0.61 +/- 0.05 and a normal difference between kidneys of 0.03 +/- 0.03. Five patients examined both before and after surgery showed a statistically significant drop in the resistive index of the obstructed kidney (0.75 +/- 0.03 to 0.65 +/- 0.05, p < .05) after surgery and a small rise in the resistive index of the contralateral kidney (0.56 +/- 0.04 to 0.63 +/- 0.04, p < .02). The resistive index appears to be an effective parameter for the evaluation and follow-up of unilateral obstructive or nonobstructive ureteropelvic junction dilatation in children.

Anorectal dysfunction and rectal prolapse in progressive systemic sclerosis

Our aim was to characterize the clinical spectrum of anorectal dysfunction among eight patients with progressive systemic sclerosis (PSS) who presented with altered bowel movements with or without fecal incontinence. The anorectum was assessed by physical examination, proctosigmoidoscopy, and anorectal manometry. There was concomitant involvement of the other regions of the digestive tract in all patients as determined by barium studies, endoscopy, or manometry: eight esophageal, three gastric, four small bowel, and two colonic. Seven patients had fecal incontinence, and four also had second-degree complete rectal prolapse. Abnormal anorectal function, particularly abnormal anal sphincter resting pressures, were detected in all patients; anal sphincter pressures were lower in those with rectal prolapse. Rectal capacity and wall compliance were impaired in seven of seven patients. Successful surgical correction of prolapse in three patients resulted in restoration of incontinence for six months and seven years in two of the three patients. We conclude that rectal dysfunction and weakness of the anal sphincters are important factors contributing, respectively, to altered bowel movements and fecal incontinence in patients with gastrointestinal involvement by PSS. Rectal prolapse worsens anal sphincter dysfunction and should be sought routinely as it is a treatable factor aggravating fecal incontinence in patients with PSS.

Delayed presentation of a contralateral, posterolateral congenital diaphragmatic hernia

Twenty cases of bilateral posterolateral congenital diaphragmatic hernia have been reported to date. Four of these patients have survived. We present a case in which an infant was readmitted, aged 8 weeks, following an initial primary repair and underwent successful surgical correction of a contralateral diaphragmatic defect. Ultrasound examination of the contralateral hemidiaphragm is suggested as a useful modality during initial assessment. In doubtful cases, where ultrasound has given equivocal information, peroperative examination of the contralateral hemidiaphragm is recommended. Failure to appreciate the existence of this rare condition may lead to inappropriate clinical management.

Supravalvular aortic stenosis after replacement of the ascending aorta

The composite graft technique for replacement of the ascending aorta in patients with aortic dissection or ascending aortic aneurysm has become widely accepted. 1 Pseudoaneurysm formation secondary to dehiscence of the suture line at the coronary anastomosis and proximal or distal graft anastomosis can occur. This potentially lethal complication has been reported to occur in 7 to 25% of patients with composite grafts and requires early detection and management. 2 We describe a patient in whom a huge anfractuous and partially thrombosed pseudoaneurysm around an ascending aortic Dacron ® graft resulted in external compression and severe obstruction of the graft with congestive heart failure. Successful surgical correction was performed. Different imaging techniques for the diagnosis of pseudoaneurysm were used. The few reported cases are revised.

Lung function in atrial septal defect after heart surgery

Lung volume, indices of lung elasticity and airway patency were measured in 74 patients, 9–21 yr old (15.0 ± 2.5 yr) with atrial septal defect (secundum type) from 2–11 (5.1 ± 2.5) yr after successful surgical correction. Clinical condition in all patients was classified as excellent. Heart surgery was performed at the age of 4–14.8 (9.9 ± 3.0) yr. Lung function abnormalities were found in 35 (47.3%) patients. Lung recoil pressure was significantly increased in 24 (32.4%) patients. The mean value of lung recoil pressure at 100% of total lung capacity reached 123 ±31 % of the predicted value ( P < 0.0001). Specific static compliance was within normal limits. Specific airway conductance was significantly reduced in 13 (17.6%) patients. Maximum expiratory flow at 25% of vital capacity was significantly reduced in 4 (5.4%) patients. Static lung volumes did not differ from reference values. Since various abnormalities of lung function tests (most frequently the tests suggested increased lung stiffness and obstruction of larger airways) were revealed in almost half of the studied children and adolescents after successful surgery for atrial septal defect, we propose to carry out lung function tests routinely as another criterion of health conditions in these patients.

Left cor triatriatum. Clinical and echocardiographic polymorphism

Four cases of cor triatriatum in children aged from 4 days to 12 months are described. In one case isolated classical form of the disease occurred, and in the other it was associated respectively to ventricular septal defect, anomalous pulmonary venous connexion and persistence of left superior venae cava. One child had successful surgical correction, two died before surgery could be attempted and one waits operation. Relevant clinical and investigational data are described and the role of echocardiography as an excellent diagnostic tool is stressed. We conclude that isolated form of cor triatriatum can simulate primary lung disease and when associated to other cardiac anomalies it has an earlier diagnosis due to early referral. Surgical results and prognosis depend not only on associated anomalies but also on early diagnosis.

Long-Term Results in Patients with Headaches Related to Nasal Obstruction

To determine if the results found at one year follow-up examinations after functional nasal surgery were valid, 70 patients suffering from both nasal obstruction and headache were reexamined 5-8 years after Cottle-type septorhinoplasties. Even though the overall rate of cure was constant, a number of patients within the different groups changed symptom patterns when contrasted to the immediate result. Although the men were more often relieved of their headaches, this tendency was not significant when compared to the one year result. Present findings show that headache can be associated with nasal obstruction due to deformities of the cartilaginous and bony septum and that the headache can be significantly reduced after a successful surgical correction. Further, this result can be stable over the years.

Balloon pulmonary valvuloplasty in the management of cyanotic congenital heart defects.

Twenty-three children with cyanotic congenital heart defects, aged 3 days to 11.5 years, weighing 2.9 to 30 kg, underwent percutaneous balloon pulmonary valvuloplasty to improve pulmonary oligemia. The patients were divided into two groups: group I with intact ventricular septum and group II with ventricular septal defect. In 12 group I patients, there was an increase of systemic arterial oxygen saturation [83 +/- 8% (mean +/- SD) vs. 94 +/- 5%, P less than 0.001] and pulmonary-to-systemic flow ratio (0.7 +/- 0.1 vs. 1.0 +/- 0.2, P less than 0.001). Peak systolic pressure gradient across the pulmonary valve decreased (P less than 0.001) from 105 +/- 48 to 25 +/- 18 mm Hg. In 11 group II patients, arterial oxygen saturation (67 +/- 13 vs. 83 +/- 13%, P less than 0.01) and pulmonary-to-systemic flow ratio (0.7 +/- 0.4 vs. 1.2 +/- 0.5, P less than 0.02) increased following valvuloplasty. Peak systolic pressure gradient across the pulmonic valve (52 +/- 16 vs. 32 +/- 22 mm Hg, P less than 0.05) decreased while infundibular and total pulmonary outflow tract gradients were unchanged (P greater than 0.1). Immediate surgical intervention was avoided in all cases in both groups. On follow-up, 1 to 36 months after valvuloplasty, arterial oxygen saturation, pulmonary-to-systemic flow ratio, and pulmonary valve gradients remain improved in both groups. However, in group I, repeat balloon valvuloplasty was required in two children. In group II, six children with tetralogy of Fallot (TOF) underwent successful total surgical correction 4 months to 2 years after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of Computed Tomographic Reconstruction in Planning Osteotomies of the Hip

Certain deformities of the hip joint seem to predispose the hip to the development of osteoarthrosis. Successful surgical correction of these deformities before the onset of osteoarthrosis requires accurate characterization of the anatomic deviations from normal as the first step in planning corrective osteotomy. Three-dimensional computed tomography (CT) reconstruction in planning reconstructive hip osteotomy has most often been employed in developmental dysplasia of the hip. Computed tomography scanning with three-dimensional reconstruction can characterize the often complex deviations from normal in shape and attitude of acetabulum and femoral head in cases with residual hip dysplasia. Three-dimensional reconstruction also allows simulation of redirectional femoral or pelvic osteotomies to facilitate precise application of newer powerful surgical techniques for reorienting the acetabulum.

Aortico-left ventricular tunnel associated with critical aortic stenosis in the newborn

Aortico-left ventricular tunnel is a rare congenital malformation. A unique case of critical aortic stenosis in a neonate accompanying aortico-left ventricular tunnel is described. Successful surgical correction was performed without invasive studies following echocardiographic recognition of the defect.

Evaluation of right ventricular function using gated equilibrium blood pool radionuclide ventriculography in patients with congenital volume and pressure overload late after surgical repair.

The effects of congenital right ventricular pressure and volume overload were studied in 3 patients with pulmonary stenosis, 7 with atrial septal defect and 6 with atrial septal defect plus pulmonary stenosis late after successful surgical correction. Gated equilibrium blood pool radionuclide ventriculography was used to measure right ventricular function at rest and during exercise and to compare it with eight normal subjects. Right ventricular ejection fractions at rest and during exercise were measured to be 61 +/- 9% and 66 +/- 13%, respectively, in the group with pulmonary stenosis, 49 +/- 7% and 54 +/- 8% in the group with atrial septal defect, and 65 +/- 13% and 69 +/- 13% in the group with atrial septal defect plus pulmonary stenosis. The values in the groups with pulmonary stenosis and atrial septal defect plus pulmonary stenosis were significantly higher than the control subjects (45 +/- 5% and 51 +/- 5%, p less than 0.01). The peak filling rate at rest and during exercise was also significantly higher in the groups with pulmonary stenosis and atrial septal defect plus pulmonary stenosis than in controls (at rest, 2.72 +/- 0.72, 2.53 +/- 0.94 vs. 1.64 +/- 0.24 p less than 0.05; during exercise, 4.38 +/- 1.23, 4.13 +/- 1.18 vs. 2.52 +/- 0.62, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

MR Imaging of Double Chambered Left Ventricle

Double chambered left ventricle is a very rare anomaly within the broader category of "subdivision of the left ventricular cavity," which includes the relatively more common congenital aneurysms and diverticulae. We report a case of an adolescent with double chambered left ventricle that MR clearly delineated, resulting in successful surgical correction.

膀胱尿管逆流と腎瘢痕

196 cases with vesicoureteral reflux (VUR) from multiple centers were analysed to examine the relationship between VUR and reflux nephropathy. The high correlation (p less than 0.01) was observed between reflux and renal scarring. Even in cases in whom VUR was not demonstrated at the time of testing, renal scarring of various degrees was recognized, suggesting either co-existed hypoplastic kidney or pre-existed infection. The renal scarring, but not VUR, had a significant correlation with proteinuria and hypertension. Retrospective analysis shows that the surgical treatment was closely related to the degree of renal scarring but not to the degree of reflux. Renal scarring progressed even when reflux did not become worse, which is probably accounted for by the presence of pyelonephritis. Although frequency of pyelonephritis decreased significantly (p less than 0.01) from 0.60 +/- 0.89 to 0.084 +/- 0.305 times/patient. year after anti-reflux surgery, renal scarring progressed in 13 kidneys (5.8%). Seven of the 13 kidneys became worse due to the surgical failure. The scar progression was recognized in the remaining six kidneys (three patients) including adult cases despite the successful surgical correction of reflux. Our study points to the urged need for a prospective clinical trial designed for the study of the pathological and clinical background of progressive renal failure in VUR.